sahr2001 - Health Systems Trust

To enable hospital managers to manage more effectively a range of issues
need to be addressed. These include: delegating more authority and
responsibility to these managers; creating more effective management
structures and systems; improving the organisational culture of hospitals and
the health department as a whole; providing more resources like equipment
and improving the infrastructure; capacity building, especially in financial
and human resource management; and the provision of incentives for
managers to manage effectively.
Conclusions
While it is important to hear the voices of politicians and managers, it is
equally important to hear the voices of front line health workers. These voices
may feature in next year’s Review.
Most of the managers and politicians who were interviewed were clearly
pleased to have been part of the transformation process. They are dedicated
to strengthening the public health service and displayed their dedication by
working long hours and largely being able to cope with the stresses of
transformation. These stresses range from successive waves of transformation,
lack of effective management systems and often lack of management skills to
ensure implementation of policies that were often determined at national
and provincial level. The interviews revealed that newly appointed managers
were enthused with the opportunity to make a difference, but often did not
fully understand the complexities of governing and managing change. In
addition, they often had to implement radically new policies without the
necessary skills and support. As one manager put it:
“One sobers down after a while, you realise that you can’t change the world,
because there are a lot of other things to cope with.”
Many of the managers interviewed loved working in the public health sector.
This is illustrated by a series of quotes used in this chapter and elsewhere.
However, the work is hard and extrinsic rewards perceived as being few in
number. The leadership of the public health sector needs to build on the
enthusiasm of managers and others that work in the public sector by providing
leadership and the necessary rewards. In addition to setting the vision, strategy
and targets, the health leadership must work harder on being a ‘soft manager’.
As Peace 3 suggests: “Soft qualities like openness and sensitivity are as critical
to success as harder qualities like charisma, aggressiveness, and always being
right”.
One thing is certain, strengthening the public health system is not a short
term job. It demands persistence, passion and commitment. Many managers
display these characteristics but these qualities need to be nurtured by all of
us who have an interest in ensuring that the public health sector provides
effective and high quality care at an affordable cost to those who depend on
it.
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